Identification of CKD, bedridden history and cancer as higher-risk comorbidities and their impact on prognosis of hospitalized Omicron patients: a multi-centre cohort study

Abstract

To further describe the effect of the “fragile population” and their “higher-risk” comorbidities on prognosis among hospitalized Omicron patients, this observational cohort study enrolled hospitalized patients confirmed with SARS-CoV-2 during the 2022 Omicron wave in Shanghai, China. The primary outcome was progression to severe or critical cases. The secondary outcome was viral shedding time from the first positive SARS-CoV-2 detection. A total of 847 participants were enrolled, most of whom featured as advanced age (>70 years old: 30.34%), not fully vaccinated (55.84%), combined with at least 1 comorbidity (65.41%). Multivariate cox regression suggested age >70 years old (aHR[95%CI] 0.78[0.61–0.99]), chronic kidney disease (CKD) stage 4–5 (aHR[95%CI] 0.61[0.46–0.80]), heart conditions (aHR[95%CI] 0.76[0.60–0.97]) would elongate viral shedding time and fully/booster vaccination (aHR[95%CI] 1.4 [1.14–1.72]) would shorten this duration. Multivariate logistic regression suggested CKD stage 4–5 (aHR[95%CI] 3.21[1.45–7.27]), cancer (aHR[95%CI] 9.52[4.19–22.61]), and long-term bedridden status (aHR[95%CI] 4.94[2.36–10.44]) were the “higher” risk factor compared with the elderly, heart conditions, metabolic disorders, isolated hypertension, etc. for severity while female (aHR[95%CI] 0.34[0.16–0.68]) and fully/booster Vaccination (aHR[95%CI] 0.35[0.12–0.87]) could provide protection from illness progression. CKD stage 4–5, cancer and long-term bedridden history were “higher-risk” factors among hospitalized Omicron patients for severity progression while full vaccination could provide protection from illness progression.

Safety and Efficacy of Outpatient Treatments for COVID-19: Real-Life Data from a Regionwide Cohort of High-Risk Patients in Tuscany, Italy (the FEDERATE Cohort)

“…Conversely, chronic heart disease was a predictor of positive outcomes. Both severe CKD and cancer emerged as higher-risk comorbidities compared with other conditions, such as old age, chronic heart diseases, metabolic disorders, or isolated hypertension, in a multicenter cohort study carried out in Shanghai, China, during the 2022 Omicron wave [ 35 ]. Moreover, CKD patients have reduced treatment options, since the use of NRM/r and RMD is contraindicated in patients with severe renal function impairment, i.e., a glomerular filtration rate less than 30 mL/min, limiting the choice to MOL and/or mAbs.…”

Neutralization against Omicron subvariants after BA.5/BF.7 breakthrough infection weakened as virus evolution and aging despite repeated prototype-based vaccination 1

“…Several studies have suggested that advanced age was the risk factor for infection and illness progression in SARS-CoV-2, both in wild-type and Omicron subvariants [ 8–10 ]. Chen et.al suggested that advanced age would lead to longer virus nucleic acid positivity duration and higher severity rate [ 11 ]. Timothy et.al raised that age negatively correlates with antibody response after vaccination alone, but no correlation in breakthrough infection or hybrid immune group among participants who received mRNA vaccines [ 12 ].…”

In-hospital adverse outcomes and risk factors among chronic kidney disease patients infected with the omicron variant of SARS-CoV-2: a single-center retrospective study

“…STOP-COVID [ 15 ]study detected higher mortality rates for both dialysis-dependent and -independent CKD patients. A multi-center study had the same conclusion as this study [ 16 ].Our study found 15.74% of patients in the CKD group developed critical COVID-19 and death. It was lower than the case fatality rate of 50% in the study conducted in the United States [ 15 ].…”